Looking Back on 10 Years of Growth

By Marvin Forland, MD, MACP

New York Times columnist Maureen Dowd recently wrote about a young boy with a passion for flying who died of septic shock due to a "perfect storm of false assumptions, overlooked data and overburdened doctors." Sully Sullenberger, hero of the 2009 Hudson River plane landing, posted a message on his tribute page, later telling Ms. Dowd, "We have a broken system... Medical professionals aren't taught these human skills some deride as the soft skills." Soft skills are what our Center is about.

As many of you know, medical ethics has been part of our school's curriculum since its inception, with major contributions from many faculty members over the years, in particular Drs. Alvin Burstein, Herman Wigodsky, Henry Perkins, Stewart Reuter and Helen Hazuda. The concern in 2002 that then-Medical School Dean Steven Wartman, MD, and I shared was the increasing failure of medical ethics to elicit student interest, let alone excitement. We came to a decision to combine medical ethics and humanities when Dr. Wartman succeeded in recruiting physician-author Abraham Verghese to head our new Center. Since then it has gained great momentum, with Ruth Berggren, MD, taking over at the halfway mark in 2007 to attract new faculty and broader community support for our program, which now has enthusiastic student support and increasing national recognition.

Dr. Berggren quickly recruited Craig Klugman, PhD. With a broad background in bioethics, he oversees curriculum development and ethics electives. An early initiative was his bilingual texaslivingwill.org, where people make their advance directives for medical care and end-of-life decisions available online. He is also working with Jason Morrow, MD, PhD, a Palliative Care ethicist, to expand the online program. Dr. Klugman directs our Arts Rounds, an elective through the McNay Art Museum using observation of fine art to sharpen students' diagnostic observation skills.

Our program was not as streamlined in the early days, however, when Dr. Verghese and co-director Tess Jones, PhD, developed the fledgling courses to help students identify and analyze ethical problems in the clinical setting. A guiding maxim, "Imagining the Patient's Experience," stressed preservation of the innate idealism and empathy of students entering medical school.

Students petitioned for more "soft skills," and the resulting group of committed faculty and volunteers who helped with the small group discussions still characterizes our Center. The nascent "On Stage Book Club" became an accredited elective course, "Literature and Medicine," taught by Dr. Jerald Winakur and Lee Robinson. Well-known writers and scholars are anticipated highlights of the Center's Bryant and Ewing-Halsell Lectures and annual Conversations About Ethics program.

Another early initiative was student-led collaboration with Galveston-based La Frontera de Salud in 2004, enabling students to work under faculty supervision in the south Texas colonias. Community service learning (CSL) was boosted with Richard Usatine, MD, starting (with medical student Amy Cantor) weekly student-led clinics at the Alpha Home for women recovering from substance abuse. Dr. Usatine became permanent faculty in 2008 and guides six student-run clinics, around which he has created two accredited courses.

In 2005, Mrs. Mary Piper, her family and other donors added global scope, funding competitive electives for students at Christian Medical College in India. Dr. Berggren expanded this program through her global health elective, now co-directed by Dr. Barbara Taylor, preparing students for and guiding them in their work in remote locations - Ethiopia, Guatemala, and Dominican Republic/Haiti. Jason Rosenfeld, MPH, who joined us in 2010, provides invaluable expertise in quality water provision research and facilitation in underdeveloped countries.

In 2008, the Center recruited Melanie Stone, M.Ed, MPH, to direct the CSL program, focusing on the mini and major grants that give students hands-on experience with community projects. Her Preparing for CSL elective and annual state-wide conference on CSL for medical and nursing school participants are major successes, with 250 attendees at this year's conference and 33 students presenting posters.

Today, soft skills are clearly gaining traction with myriad initiatives, programs and endowments supported by generous donors. Our students are engaged, as is the Center's Community Advisory Council, which still guides us as it did when Edith McAllister became our first chair in 2002. By enabling students to experience "ethics in action," a term coined by Dr. Berggren, the Center is moving toward a lofty goal - "preparing tomorrow's healers to act with compassion and justice."